Followers

Sunday, October 26, 2008

For the past three weeks, each issue of The New England Journal of Medicine has featured viewpoints on the pressing health-care policy issues facing the next administration. These topics (in case you haven’t heard) include health insurance and rising health-care costs, and how to balance them economically, ethically, and politically.

I see the insanity of the current “system” pretty much every day.

For instance: the patient crippled by diabetes at age 60, unable to hold a job, and therefore out of luck when it comes to health insurance—too young for Medicare, slightly too wealthy for Medicaid. The older man with lengthy illnesses who’s “used up” his eligibility for rehabilitation and is forced to pay out of pocket. The transplant patient trying to figure out how to pay for the medications that keep the transplant working. Medicare would pay tens of thousands of dollars for dialysis, should her kidney fail—but it won’t cough up the hundreds of dollars to cover medications that will prevent that from happening in the first place.

These people face unfathomable financial stress in the midst of significant illness.

I’ve asked patients to come to the emergency room because of disturbing symptoms or lab-test results, only to have them tell me that they fear a denial letter and the ensuing insurance fight, should the ER evaluation reveal that nothing is wrong.

I also see patients like those highlighted in this week’sNew York Times health section—people deciding not to take some or all of their medications because of the cost. Sure, some of those people will do OK. There are well-documented problems with polypharmacy (when too many medications actually create health problems), particularly in older adults. And not every person at risk for a disease (heart disease and stroke, for instance) will actually get it without being treated.

But many who skimp on their meds to save money will pay the price later, when uncontrolled high blood pressure leads to a stroke, or undertreated diabetes leads to vision loss or heart disease.

It used to be said disparagingly of Britain’s national health system that it ought to be called the “national sickness system.” Well, that’s what we’ve got here in the United States: a sick system. Without extending coverage beyond the employed, the impoverished, and those at the extremes of age, there will be no cure. Massachusetts has made a tremendous step in this direction. The rest of the nation should watch and learn.